Your Name
*
Your Title
Phone Number
*
Email Address
*
Main Point of Contact (POC)
Check here if you are the main POC.
Same
POC Name
*
POC Phone
*
POC Email Address
*
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Business Information (legal)
Business Legal Name
*
Business Legal Mailing Address
*
Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
What type of business is this?
*
Sole Proprietor / Entreprenuer / Freelancer
Small Business
Non-profit Organization
How long have you been in business?
*
Haven't launched
Less than a year
1-5 years
5 years or more
How many employees do you have? (include contractors)
*
It's just me.
2 - 10
less than 25
25 - 50
50 - 100
More than 100
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Business Information (published)
Business Nickname or Acronym
How your customers might refer to your business.
Business Tagline
Business Website URL
*
If there is no website, type N/A.
Business Blog URL
Business Phone Number
Business Email Address
Is this a brick and mortar business? ( physical location)
*
Yes
No
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Zip Code
Do you have more than one location?
*
Yes
No
How many?
*
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Market / Industry Information
Describe your business.
*
Basically, your elevator pitch.
What is your primary industry / niche?
*
Secondary industry / niche?
In order of importance, what are the top 1-3 products or services you are focused on selling?
Product / Service #1
*
Product / Service #2
Product / Service #3
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Describe your ideal customer/client: (age, sex, income, location, etc…)
*
Name the top 3 - 5 things about you / your company that make you unique in the marketplace / better than your competition?
*
What are your short-term business goals? (1 yr)
*
What are your long-term business goals? (3-5 yrs)
*
Describe any upcoming business opportunities?
What are the top 3 marketing challenges?
*
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Social Media
Do You Have Social Media Accounts for Your Business?
*
Yes
No
Who manages your social media?
*
How often do you engage with your followers and post on social media?
*
1-3 times daily
1-2 times weekly
1-2 times per month
Google My Business URL
Facebook Business Profile URL
Instagram/Threads Business Profile URL
Twitter/X Business Profile URL
TikTok Business Profile URL
LinkedIn Business Profile URL
Pinterest Business Profile URL
YouTube Business Profile URL
Snapchat Business Profile URL
Other
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Request For Services
What are your immediate marketing needs? (check all that apply)
Web Design (websites, landing pages, blogs, ecommerce, communities)
Social Media (campaigns, management, strategy, advertising, selling)
Email Marketing (campaigns, automation, lead gen, newsletters, etc.)
Content Marketing (create engaging content across various mediums)
Search Engine Marketing (paid ads to rank higher in search)
Search Engine Optimization (organic methods to rank higher in search)
Paid Advertising (Google Ads, social media ads, retargeting)
Conversion Rate Optimization (website audit, data analytics, strategy)
Brand Identity (logo, business cards, aesthetic, messaging, strategy)
Graphic Design (flyers, signage, banners, display ads, social media, etc.)
Marketing Consulting (strategy and coaching)
Other
What are your marketing expectations?
What is your estimated project budget?
*
Please Select
$500-1000
$1000-3000
$3000-5000
$5000+
When can we get started?
*
/
Month
/
Day
Year
Date
How did you hear about Socially Active Media?
*
Referral
Social Media
Web Search
Online Ad
Blog Post
Sales Rep
Event
Other
Referral Name (so we can say thanks!)
Anything else we should know.
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